Oxford Policy Management

This study examines how survivors of firearm violence engage with and make meaning through online survivor networks as part of their efforts to navigate trauma, reconstruct identity, and sustain social belonging. Using a hermeneutic phenomenological approach, I conducted an embedded subgroup analysis of 12 self-identified survivors drawn from a larger sample of 33 interviews. Survivors described online networks as sources of shared language, legitimacy, and meaning that helped them articulate their experiences. These spaces also offered emotional and practical support, often filling gaps left by formal health and social services. Beyond interpersonal support, survivors framed these networks as sociotechnical environments that shape how survivorship is recognized, negotiated, and performed. They experienced online networks as sites of civic and advocacy engagement, providing opportunities that could empower action but also introduce expectations and constraints. Survivors highlighted the complexity of negotiating visibility and disclosure within these communities, balancing personal needs for healing with pressures to perform survivorship. Overall, the findings suggest that online survivor networks function as vital yet contested infrastructures for recovery and identity reconstruction. By foregrounding the social, relational, and digitally mediated processes through which survivors craft meaning and legitimacy, this study extends qualitative understandings of digitally mediated trauma recovery and conceptualizes online peer support as an integral, though unevenly accessible, component of contemporary health and social care landscapes. • Survivor networks play a role in reconstructing identity and making sense of trauma. • Online networks act as a sociotechnical infrastructure influencing recovery. • Networks provide emotional support and pathways for civic and policy engagement. • Hermeneutic phenomenology reveals nuanced experiences in a networked subsample. • Survivor engagement evolves over time, balancing visibility, advocacy, and healing.

Intimate partner violence (IPV) is a significant barrier to HIV prevention service utilization, yet little is known about its impact on pre-exposure prophylaxis (PrEP) adherence among gay, bisexual, and other men who have sex with men (GBMSM). This study examines the association between IPV victimization and PrEP adherence using data from an online survey of 937 current PrEP users in Ukraine, conducted in early 2022, a few days before Russia's invasion. Participants reported on six types of IPV experienced in the past six months, physical, sexual, emotional, and financial abuse as well as partners' monitoring and controlling behaviors. Further, they self-reported their PrEP adherence and were asked to describe the reasons for missing PrEP medications through an open-ended question. Nearly 40% of respondents experienced at least one form of IPV, with sexual and emotional IPV being most common. Only 35.4% reported excellent or very good adherence to PrEP medication. Self-reported reasons for missed doses included COVID-19 restrictions, changes in sexual behavior, use of alternative HIV prevention methods, and health or psychological factors. In multivariable models adjusting for sociodemographic and behavioral factors, sexual IPV, monitoring, and controlling IPV were associated with higher PrEP adherence. The positive association may suggest that IPV survivors increase their PrEP adherence as a protective strategy against HIV infection. These findings highlight the importance of integrating trauma-informed IPV screening and support within PrEP programs and adopting flexible service models to sustain adherence, especially during social and political crises. Future longitudinal research should explore mechanisms linking IPV and PrEP adherence and develop structural interventions to better support this vulnerable population.

Psychiatric disorders are associated with increased risk of suicide-related outcomes, and the impact of pharmacological treatments on these outcomes is uncertain. Although randomised controlled trials are the main approach to evaluate efficacy, they may not provide externally valid results for suicide prevention in psychiatric populations. Thus, we aimed to synthesise the evidence on the effect of psychotropic medications on suicide-related outcomes from observational studies. In this systematic review and meta-analysis, we systematically searched Ovid (MEDLINE, Embase, APA PsychArticles, AMED, BIOSIS, Global Health, PsycINFO), and Web of Science Core Collection from database inception to 8 December 2025 for pharmacoepidemiological and other observational studies on suicide-related outcomes in people treated with the main types of psychotropic medications: antidepressants, antipsychotics, mood stabilisers (including antiepileptics), and medications for anxiety (anxiolytics), attention deficit and hyperactivity disorder (ADHD), and substance use disorder (SUD). We included primary studies involving adults with common psychiatric diagnoses (schizophrenia spectrum disorders, bipolar disorder, depressive disorders, and personality disorders), who were prescribed medication and a comparison sample with the same diagnosis without prescribed medication (between-individual studies) or the same individuals during a non-prescription period (within-individual studies). We excluded studies that did not report psychiatric diagnoses and from selected samples. Outcomes were suicide attempts/self-harm and suicide mortality. We pooled effect sizes as odds ratios (OR), hazard ratios (HR) or risk ratios (RR) using random-effects models and assessed study quality using NOS and QUIPS tools. Study protocol was registered with PROSPERO, CRD42024515794. Of 5653 records identified, 48 independent studies from 13 countries based on more than 6 million people (47% male) met inclusion criteria. Across the main diagnostic categories and 70 individual medications examined, associations with reducing risk of suicide mortality were found for second generation antipsychotics in schizophrenia spectrum disorders: clozapine (OR = 0.40; 0.36-0.60; I2 = 60%, moderate certainty), olanzapine (OR = 0.53; 0.39-0.71; I2 = 34%, high certainty), quetiapine (OR = 0.75; 0.58-0.96; I2 = 0%, high certainty), and zuclopenthixol (OR = 0.44; 0.30-0.63; I2 = 0%, high certainty). In schizophrenia, second generation antipsychotics were also associated with reduced risks of suicide attempts: olanzapine (OR = 0.76; 0.60-0.98; I2 = 84%, moderate certainty) and risperidone (OR = 0.61; 0.52-0.72; I2 = 57%, moderate certainty). In bipolar disorder, lithium (OR = 0.38; 0.28-0.50; I2 = 67%, moderate certainty) and valproic acid (OR = 0.66; 0.59-0.75; I2 = 0%, high certainty) were associated with lower suicide risks, and lithium was also associated with lower risks of suicide attempts (OR = 0.60; 0.44-0.82; I2 = 92%, moderate certainty). In depression, associations with lower risk of suicide mortality for selective serotonin reuptake inhibitors (SSRIs) (OR = 0.61; 0.47-0.81; I2 = 23%, high certainty) and tricyclic antidepressants (OR = 0.68; 0.59-0.78; I2 = 0%, high certainty) were found. Benzodiazepines were associated with higher risk of suicide mortality in most diagnostic categories, except depression. There was some evidence for publication bias for lithium in bipolar disorder and clozapine in schizophrenia spectrum disorders, leading to more papers reporting lower risks of suicide-related outcomes. The risk of bias in included studies was low in 47 studies, moderate in one study, and certainty of evidence was moderate. There is evidence of varying effects of psychotropic medication on the risk of suicide-related outcomes across different psychiatric disorders. The appropriate use of prescribed medications in people with high risks of suicide-related outcomes is an important suicide prevention strategy. Findings are not causal, and limitations include the observational nature of included studies, risk of residual confounding, high heterogeneity for some outcomes, and moderate quality of the evidence. University of Oxford (Hill Foundation), NIHR Oxford Health Biomedical Research Centre, Wellcome Trust.

Abstract This paper asks whether police vetting decision-makers are influenced by ethnic characteristics of applicants. Using seven vignette scenarios and random allocation of applicant ethnicity and name ( n = 1,778 decisions), we were able to test whether applicant-stated ethnicity and name affected vetting decisions. We found that in five of seven scenarios ethnicity did not influence vetting approval. However, in two scenarios we found that ethnic minority group membership led to lower vetting approval rates compared to the reference group of White applicants. This study, the first to test vetting decision-makers experimentally, illustrates that ethnic group membership can affect vetting approval decisions in more complex situations. Implications for training, practice and policy are discussed and we set out some options for reducing the risk of bias and how this work has informed policy in this area.

Abstract This study investigates the role of class origin compositions of micro-occupations in creating economic inequalities using three decades of British longitudinal surveys. Drawing on social closure theory, we analyze how class origin contributes to between-occupation earnings disparities and class origin earnings inequality at the individual level. Using fine-grained data on the class origins of occupational incumbents, we construct a robust indicator of the concentration of privileged class origins within labor market niches, “occupational elitism,” measured as the percentage of incumbents with parents in the higher salariat (ESeC class 1) within an occupation. Our results reveal that occupational elitism of micro-occupations is positively associated with earnings, after accounting for indicators of positional closure mechanisms, such as educational credentialing, licensure, and unionization. However, these collective earnings premiums are unevenly distributed, with earnings advantages for individuals from upper-class families emerging in occupations with higher levels of occupational elitism.

Violence exposure is a well-established risk factor for adolescent conduct problems, yet longitudinal research in high-adversity, low- and middle-income countries (LMICs) remains limited. This study investigated whether early adolescent violence exposure predicts concurrent and longer-term conduct problems, and explored potential bidirectional associations and sex differences in a peri-urban South African community with high rates of poverty and violence. Data were drawn from the Thula Sana birth cohort (n = 357; 51.5% female), a longitudinal intervention study in Khayelitsha, South Africa. Adolescents were assessed at early (ages 12-14) and late adolescence (ages 16-19). Violence exposure was measured using adolescent self-report. Conduct problems were measured using adolescent and caregiver report in early adolescence and adolescent self-report in late adolescence. Multiple linear regressions tested cross-sectional associations, and cross-lagged panel models examined longitudinal and bidirectional associations, adjusting for contextual adversity and intervention status. Missing data were addressed using multiple imputation, and findings were confirmed through sensitivity analyses. Violence exposure was associated with higher concurrent conduct problems in early adolescence (β = .15-.19, p < .01) and predicted higher conduct problems in late adolescence (β = .12-.14, p < .05). The reverse pathway, from conduct problems to subsequent violence exposure, was not significant (β = .08-.11, p > .05). Interaction analyses did not provide evidence that associations differed by sex. Violence exposure in early adolescence represents a prospective risk factor for conduct problems in a high-adversity South African setting. Findings highlight the importance of early, contextually grounded violence prevention and the need for further research to test sex-specific pathways and inform the development of gender-responsive intervention strategies.

The risk of HIV acquisition is heightened during pregnancy and early parenthood with the additional risk of vertical HIV transmission. While recent studies have improved our understanding of PrEP use among pregnant and breastfeeding women, further evidence is needed to inform the design of interventions that support sustained use, especially among young women who are pregnant or parenting. We analysed data from young women aged 15-29 years who initiated PrEP in an implementation study (FastPrEP) in Cape Town, South Africa. Logistic regression was used to examine the association between pregnancy or parenting status (≥ 1 living child) and PrEP discontinuation at 1- and 4-months post-initiation, based on pharmacy refill data. The primary exposure was currently pregnant or having a child (vs. not); secondary analyses stratified by age (15-24 vs. 25-29 years) among women who were pregnant/parenting. Models were adjusted for age and hypothesised explanatory factors were included in sensitivity analysis: service delivery location, contraceptive use, HIV risk perception, and relationship status. Between August 2022 and June 2024 n = 4,876 young women initiated PrEP; 44% were pregnant/parenting (of which 10% were pregnant), and the median age was 21.6 years (IQR:18-25). At 1-month, women who were pregnant/parenting had higher odds of PrEP discontinuation (aOR:1.30, 95% CI:1.14-1.49). At 4-months this relationship persisted (aOR:1.41, 95% CI:1.12-1.78) compared with non-pregnant/parenting women. Among those pregnant/parenting, younger women (15-24 years) had higher odds of discontinuation at 1-month (aOR:1.31, 95% CI:1.08-1.58) and 4-months (aOR:1.41, 95%CI:1.02-1.96) compared to women aged 25-29. In the fully adjusted multivariable model, receiving PrEP in mobile clinics (aOR:0.71, 95% CI:0.61-0.82) vs. government clinics was associated with lower odds of early discontinuation. Young women who are pregnant/parenting face elevated risk of early PrEP discontinuation. Differentiated, life-stage and youth-responsive interventions, such as counselling, partner involvement, and integration with maternal and child health, or sexual and reproductive health services, are critical to improving PrEP persistence among this priority population. This population should be prioritised in the rollout of long-acting PrEP formulations, which may better align with their needs and reduce the burden of daily adherence.

ObjectiveTo describe well-care visit attendance among children of adolescent mothers living with HIV and HIV-negative adolescent mothers and identify factors associated with optimal retention in the well-care visit schedule up to 18 months.Design, setting, participantsCross-sectional data were used from a community-based observational cohort study of adolescent mothers (10–19 years; n=481) and their children (≥19 months old; n=502) in the Eastern Cape, South Africa.OutcomeOptimal well-care visit retention up to 18 months was defined as attending visits within 4 weeks of the recommended child age, attending the 18-month visit and missing no more than one scheduled visit.ResultsAttendance was highest at the 6-week visit (88.4%; 95% confidence interval (CI) 85.6% to 91.3%) and lowest at the 18-month visit (58.0%, 95% CI 53.6% to 62.3%). About one-third (36.1%; 95% CI 31.8% to 40.3%) of children were retained to 18 months. Retention was highest among children living in rural vs urban areas (adjusted odds ratio (aOR)=2.01, 95% CI 1.32 to 3.06), those born to mothers whose highest education at pregnancy was secondary versus primary school (aOR=2.73, 95% CI 1.60 to 4.65), born via caesarean section vs vaginal birth (aOR=1.65, 95% CI 1.05 to 2.60) and living closer to the clinic (aOR=0.52, 95% CI 0.28 to 0.96 for long vs short distance). There was weak evidence that retention was lower among children of mothers living with HIV (aOR=0.64, 95% CI 0.40 to 1.02) and higher among food-secure children (aOR=2.18, 95% CI 0.96 to 4.96) and those receiving the child support grant (aOR=1.71, 95% CI 0.92 to 3.16).ConclusionsUniversal interventions are needed for retention beyond the neonatal period for children of adolescent mothers living with HIV and HIV-negative adolescent mothers. Interventions must address structural barriers, especially for adolescent mothers with primary education and in urban areas. Future research should examine the underlying mechanisms linking mode of delivery with well-care retention.

IntroductionThe Imagine programme is a school-based HIV prevention program offering preexposure prophylaxis (PrEP), condoms and other social and structural interventions to adolescent girls and young women (AGYW) in South Africa. PrEP uptake and adherence together with the provision of condoms has not been extensively studied in the school context. We explored the barriers to and facilitators of PrEP and condom usage among Imagine programme beneficiaries using the HIV prevention cascade framework.MethodsSixteen AGYW aged 16–20 years who had never taken PrEP, were on PrEP or had stopped PrEP were interviewed between November 2023 and March 2024. Interviews were audio-recorded, and transcripts were deductively coded according to the HIV prevention cascade steps: (1) Knowledge, (2) Motivation, (3) Access and (4) Effective use.ResultsHIV and pregnancy risk awareness was high. For condom use, the risk of HIV transmission and pregnancy was outweighed by fear of sexual or physical violence from male partners and a desire to maintain relationships, as asking to use condoms demonstrated a lack of trust. High levels of PrEP knowledge motivated participants to use PrEP, especially if their partner refused to use condoms. Fear of side effects and daily pill taking were barriers to PrEP uptake. PrEP and condom services in school were highly acceptable, while anticipated stigma remained a challenge at the community clinic.DiscussionBarriers to condom use persist in South Africa, but positive attitudes toward PrEP described in this study suggest that opinions about PrEP are still forming and can be strongly influenced by youth-friendly HIV programming in schools.